Despite significant advances in the surgical and medical treatment of congenital heart disease, many patients continue to have problems with ventricular performance both before and after therapy. The time course over which irreversible changes in myocardial function occur in patients with congenital heart disease remains speculative in most instances and is probably dependent on duration and extent of hemodynamic overload, duration and degree of cyanosis and duration and extent of perioperative myocardial injury. This review summarizes existing data regarding ventricular performance in patients with congenital heart disease both before and after surgical intervention.